Treatment of a supracondylar fracture
Date First Published:
July 13, 2005
Last Updated:
July 14, 2005
Report by:
Pranam Patel, student (Manchester Royal Infirmary)
Search checked by:
pranam patel, Manchester Royal Infirmary
Three-Part Question:
in a [child aged 3-12] with a [spracondylar fracture of the humerus] is a [better outcome achieved with surgical intervention or immobilisation]
Clinical Scenario:
An eight year old child presents with pain, swelling and local tenderness of the elbow, having fallen onto an outretched hand. a supracondylar fracture of the humerus is suspected. should this patient be treated with immobilisation or referred for surgery
Search Strategy:
Medline 1966-June 20005
CINAHL 1982-June 2005
The Cochrane library, isuue 2 2005
CINAHL 1982-June 2005
The Cochrane library, isuue 2 2005
Outcome:
98 citations of which 2 high quality retrospective studies were found
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Supracondylar fracture of the humerus in children Palmer EE Jul-78 USA | 78 children (children's hospital) | retrospective clinical trial | volkmann's contracture | no instances following either mode of treatment | The study was promoting screws of their own deign, so possibly could be bias in interpreting results. Some patients discontinued follow up. Treatments not randomly allocated, varied depending on the state of the fracture (e.g. displaced or not; absent radial pulse or not) making comparisons between treatments difficult |
| best mode of treatment | surgery associated with better oucome than immobilisation | ||||
| best mode of surgery | overhead traction associated with best outcome | ||||
| complications following surgery | rapid reolution of any neurovascular comprimise secondary to surgery | ||||
| Surgical treatment of displaced supracondylar fractures of the humerus in children Weiland AJ Jul-78 USA and Switzerland | 52 chidren, aged 2-13 years old | retrospective review | complications following treatment | no cases of infection, non-union, anaesthetic complications, or evidence of myositis ossificans | statistical methods used are not described |
| pre-operative neurovascular complications | all children had complete recovery within 14 days after surgery | ||||
| complications of surgery | no patient suffered neural or vascular injury secondary to surgery | ||||
| Angulation | 13/52 patients had less valgus angulation compared to uninjured elbow following surgery. 1/52 patients developeed cubital varus deformity |
Author Commentary:
treatment of a supracondylar fracture of the humerus is a difficult task as this type of fracture is associated with many complications.
Bottom Line:
surgical intervention leads to improved outcome in a supracondylar fracture of the humerus
References:
- Palmer EE. Supracondylar fracture of the humerus in children
- Weiland AJ. Surgical treatment of displaced supracondylar fractures of the humerus in children